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Giannaccare G, Bolognesi F, Biglioli F, Marchetti C, Mariani S, Weiss JS, Allevi F, Cazzola FE, Ponzin D, Lozza A, Bovone C, Scorcia V, Busin M, Campos EC. In Vivo and Ex Vivo Comprehensive Evaluation of Corneal Reinnervation in Eyes Neurotized With Contralateral Supratrochlear and Supraorbital Nerves. Cornea 2020; 39:210-214. [PMID: 31335523 DOI: 10.1097/ico.0000000000002083] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To use an automated morphometric analysis system of in vivo confocal microscopy (IVCM) images for evaluating reinnervation occurring at the subbasal nerve plexus (SNP) after direct corneal neurotization (DCN) and to further report neurophysiological and histopathological findings. METHODS Prospective interventional case series including 3 eyes with neurotrophic keratitis that underwent DCN. Deep anterior lamellar keratoplasty was performed 18 months after DCN in patient 1. The following evaluations were performed before and at 3, 6, and 12 months after DCN: clinical evolution of keratitis; corneal sensitivity; IVCM images of the SNP analyzed with "ACCMetrics;" neurophysiological study of corneal reflex. Protein gene product 9.5 immunofluorescence staining assay and transmission electron microscopy were conducted on the neurotized button excised during deep anterior lamellar keratoplasty. RESULTS Complete healing was obtained in all patients by 3 months postoperatively. Corneal sensitivity was absent preoperatively in all eyes and improved after surgery, reaching an average value of 30 mm 1 year postoperatively. The corneal SNP was not visible at IVCM in any of the cases preoperatively and became visible by 3 months postoperatively, showing IVCM metrics comparable to normal contralateral eyes at 1 year. In all cases, neurophysiological evaluation showed a partial recovery of the electrical activity of the cornea. In patient 1, protein gene product (PGP) 9.5 staining of neurotized cornea showed nerve fascicles at the SNP, whereas transmission electron microscopy showed amyelinic nerve axons and nerve endings. CONCLUSIONS The corneal SNP exhibited IVCM metrics comparable to the normal contralateral eye 1 year after DCN. Ex vivo histopathological assessment of neurotized corneas confirmed the presence of nerves with normal ultrastructure.
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Affiliation(s)
- Giuseppe Giannaccare
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Ophthalmology, University "Magna Graecia," Catanzaro, Italy
| | - Federico Bolognesi
- Oral and Maxillofacial Surgery, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Biglioli
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Mariani
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Jayne S Weiss
- Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans, LA
| | - Fabiana Allevi
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federica E Cazzola
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, the Veneto Eye Bank Foundation, Venice, Italy
| | - Alessandro Lozza
- Service of Neurophysiopathology-National Neurological Institute "C. Mondino," Pavia, Italy
| | - Cristina Bovone
- Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; and.,Department of Morphology, Surgery and Experimental Surgery, University of Ferrara, Ferrara, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University "Magna Graecia," Catanzaro, Italy
| | - Massimo Busin
- Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; and.,Department of Morphology, Surgery and Experimental Surgery, University of Ferrara, Ferrara, Italy
| | - Emilio C Campos
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Giannaccare G, Pellegrini M, Taroni L, Bernabei F, Bolognesi F, Biglioli F, Sebastiani S, Moscardelli F, Cazzola FE, Campos EC. Longitudinal Morphometric Analysis of Sub-Basal Nerve Plexus in Contralateral Eyes of Patients with Unilateral Neurotrophic Keratitis. Curr Eye Res 2019; 44:1047-1053. [DOI: 10.1080/02713683.2019.1623899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Giuseppe Giannaccare
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Marco Pellegrini
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Leonardo Taroni
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Bernabei
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Bolognesi
- Oral and Maxillofacial Surgery, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Biglioli
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Stefano Sebastiani
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fabiana Moscardelli
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federica E. Cazzola
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Emilio C. Campos
- Ophthalmology Unit, DIMES, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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